5.2. Antifungal drugs
5.2.1. Triazole antifungals
Prescribing Notes:
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
Restrictions:
The use of itraconazole in the treatment of fungal nail infections is non-Formulary.
Restrictions:
Restricted to specialist use only. Use for the prophylaxis of invasive fungal infections in immunocompromised patients is restricted to patients in whom there is a specific risk of aspergillus infection or where fluconazole or itraconazole are not tolerated in accordance with local protocol. In addition use for treatment is restricted to patients in whom there is a specific risk of Aspergillus infection or where fluconazole or itraconazole are not tolerated on the advice of local microbiologists or specialists in infectious diseases.
Prescribing Notes:
Different formulations of posaconazole may differ in dosing and absorption and are not interchangable.
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to use on the advice of microbiologist/ haematologist primarily in immuno-compromised patients with progressive, possibly life-threatening infections. Treatment of candidaemia in non-neutropenic patients is restricted to those who cannot tolerate amphotericin B therapy or who are at an increased risk of serious side effects with amphotericin.
Prescribing Notes:
Prophylaxis of invasive fungal infections in high risk allogeneic hematopoietic stem cell transplant (HSCT) recipients remains non-Formulary.
The shared care protocol for prescribing of voriconazole for invasive aspergillosis is currently suspended and prescribing should be routinely undertaken in the acute setting.
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
5.2.2. Imidazole antifungals
5.2.3. Polyene antifungals
Restrictions:
Restricted to specialist use only. Prescribe only on Microbiology / Infectious Diseases advice.
Is restricted to use in systemic mycoses when toxicity (especially nephrotoxicity) precludes the use of non-liposomal amphotericin.
Prescribing Notes:
Prescribe by name of specific product used (AmBisome® or Tillomed Liposomal Amphotericin B).
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to specialist use only. For fungal infections involving the urinary tract only on Microbiology / Infectious Diseases advice.
Prescribing Notes:
Prescribe by brand name (Fungizone®).
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
5.2.4. Echinocandin antifungals
Restrictions:
Restricted to specialist use only. The treatment of invasive candidasis in adults is restricted to use on the advice of a consultant microbiologist where other treatment options are unsuccessful or inappropriate.
Prescribing Notes:
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to specialist use only.
Caspofungin is restricted to adult and paediatric patients with fluconazole-resistant Candida infection unresponsive to or who cannot tolerate amphotericin B therapy.
Restricted for empirical therapy for presumed fungal infections in febrile, neutropenic adult and paediatric patients on the advice of microbiologists or specialists in infectious diseases.
It is not recommended by SMC for invasive aspergillosis.
Prescribing Notes:
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
Restrictions:
Restricted to specialist use only for the treatment of invasive candidiasis in adults, elderly, and children (including neonates) where other treatment options are unsuccessful or inappropriate. It is restricted to specialist use only on the advice of a consultant microbiologist or infectious disease physician.
Prescribing Notes:
Use for the treatment of oesophageal candidiasis, or for the prophylaxis of Candida infection in patients undergoing allogeneic haematopoietic stem cell transplantation or patients who are expected to have for 10 or more days is not recommended by SMC and is non-Formulary.
Restrictions:
Restricted to specialist use only for the treatment of invasive candidiasis in adults.
Prescribing Notes:
Please note: this is a PROTECTED ANTIFUNGAL (see policy here) and relevant paperwork should be completed.
5.2.5. Other antifungals
Prescribing Notes:
Terbinafine is particularly useful for systemic treatment of skin and nail fungal infections.